Journal Article

The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease

Jan-Peter van Kuijk, Willem-Jan Flu, Michel Chonchol, Gijs M.J.M. Welten, Hence J.M. Verhagen, Jeroen J. Bax and Don Poldermans

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 6, pages 1882-1888
Published in print June 2010 | ISSN: 0931-0509
Published online January 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfp756
The prevalence and prognostic implications of polyvascular atherosclerotic disease in patients with chronic kidney disease

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Background. Atherosclerotic disease is often extended to multiple affected vascular beds (AVB). Polyvascular disease (PVD) and chronic kidney disease (CKD) have both separately been associated with an adverse cardiovascular outcome. We assessed the prevalence of PVD in vascular surgery patients with preoperative CKD and studied the influence on long-term cardiovascular survival.

Methods. Consecutive patients (2933) were preoperatively screened for PVD, defined as 1-, 2- or 3-AVB. Preoperative glomerular filtration rate (GFR in ml/min/1.73 m2 body-surface area) was estimated by the Modification of Diet in Renal Disease (MDRD) prediction equation, and patients were categorized according their estimated GFR. Primary end point was (cardiovascular) mortality during a median follow-up of 6.0 years (IQR 2–9).

Results. Preoperative MDRD-GFR was classified as normal kidney function (GFR ≥ 90) or mild (GFR 60–89), moderate (GFR 30–59) and severe (GFR < 30) kidney disease in 779 (27%), 1423 (48%), 605 (21%) and 124 (4%) patients, respectively. One-vessel disease was present in 54% of the patients with normal kidney function, while 62% of the patients with CKD (GFR < 60) had PVD. In patients with moderate or severe kidney disease, the presence of PVD was independently associated with even higher cardiovascular mortality rates (2-AVB: HR 1.65 95%CI 1.09–2.48; 3-AVB: 2.07 95%CI 1.08–3.99), compared to 1-AVB.

Conclusion. Patients with CKD had a high prevalence of PVD, which was independently associated with increased all-cause and cardiovascular mortality.

Keywords: chronic kidney disease; polyvascular disease; prevalence; prognosis

Journal Article.  4244 words.  Illustrated.

Subjects: Nephrology

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